Impact of Emotional Distress on Prescription Opioid Abuse in a Rural Juvenile Drug Court Sample

Background: Ohio is at the epicenter of the opioid epidemic, and the current crisis disproportionately burdens rural areas. The Self-Medication Hypothesis and work examining adverse childhood experiences posit that drug use may be understood as a coping strategy to address emotional distress.Methods: Juvenile drug court participants in a Northwest Ohio county were administered a standardized biopsychosocial assessment. Intake interviews from January 2010 and November 2018 were used to evaluate the relationship between emotional distress reported using the Emotional Problem Scale (EPS) and lifetime nonmedical use of prescription opioids. Linear regression was used to examine temporal trends in EPS scores. Logistic regression was used to examine the relationship between EPS scores and prescription opioid misuse, controlling for temporal trends.Results: Linear regression showed a significant increase in emotional distress over the study period for both pre-scription opioid users and nonusers. Average scores increased 29.5 points (on a 100 point scale) over the duration of the study (P <0.0001). A 10-point increase in EPS score was associated with a nearly 50% increase in the lifetime odds of pre-scription opioid misuse (OR = 1.46, 95% CI: 1.19-1.82, P = 0.0004). The odds of prescription opioid misuse declined each year (OR = 0.63, 95% CI: 0.48-0.81, P = 0.0006).Conclusion: Rates of prescription opioid misuse have decreased over time despite a significant association be-tween emotional distress and opioid misuse and trend toward increasing EPS scores. While efforts to reduce prescription opioid misuse appear to have been effective in this population, significant work is needed to reduce underlying risk fac-tors

Human Development and Controlled Substance Prescribing in Ohio Counties

Background: Human development is a holistic measure of well-being. The American Human Development Index (AHDI) operationalizes the concept for the American context, using a composite measure of income, education, and health. This work presents the first county-level examination of AHDI for the state of Ohio and examines the relationship between human development and controlled substance prescribing.Methods: Publicly available data from the census and prior publications were compiled to calculate county-level AHDI for all 88 Ohio counties. Correlations were examined between AHDI and 4 classes of controlled substances, opioids, benzodiazepines, stimulants, and sedatives, using Pearson product moment correlation coefficient.Results: County AHDI scores ranged from 3.3 to 7.6, with mean and median values of 4.8. At the county level, human development is negatively correlated with opioid (r = -0.46, r2 = 0.22, P <0.0001) and benzodiazepine (r = -0.43, r2 = 0.18, P <0.0001) prescribing and positively associated with stimulant prescribing (r = 0.49, r2 = 0.24, P <0.0001). Neither sedative prescribing practices (r = 0.09, P = 0.40) nor median age (r = -0.09, P = 0.41) were significantly correlated with AHDI.Conclusion: There is a strong correlation between AHDI and prescribing of several classes of controlled substanc-es. Work remains to ascertain mechanisms and directionality of these relationships. Whether higher prescribing in areas with lower human development is an attempt to medicate health inequity or low human development is an additional manifestation of the opioid epidemic, this study underscores the necessity of pursuing equity in all policies

Applying Publicly Available Contextual Factors to Predict Smoking Relapse in a National Sample

Background: The ecological fallacy is broadly understood, though its complimentary problem, the individualistic or atomistic fallacy, isless often considered. Multilevel models offer the statistical tools needed to avoid both errors by allowing simultaneous considerationof individual, contextual, and policy factors. This study applies such methods to smoking cessation data. Tobacco control is of particularconcern in Ohio where the adult smoking prevalence remains around 22%.Methods: Data from the 1,785 participants in the Technology Enhanced Quitline Study were used to test the theory that contextualfactors impact relapse rates and program effectiveness, employing a mixed-effects model to account for the nested nature of the datawhile testing for the relationship between contextual factors and relapse, controlling for individual characteristics.Results: No contextual factors or policy variables were significant predictors of smoking relapse in the sample, nor were any associated with the success of the intervention.Conclusions: While this work could not identify specific influences of contextual and policy factors on smoking outcomes in our sample, it demonstrates the feasibility of adding such predictors to future clinical trials. This project clearly does not rule out the possibility that contextual and policy factors may influence smoking even after controlling for individual characteristics, but does not provide strong evidence of such a link. It is possible that these negative findings may be due to geocoded mailing addresses being a poor proxy for relevant contextual factors, use of the wrong geographic unit of analysis (modifiable areal unit problem), or a lack of temporal resolution in contextual variables

Automated Telephone Monitoring for Relapse Risk among Recent Quitters Enrolled in Quitline Services

poster abstractThis study is part of a randomized controlled trial to test the efficacy of interactive voice response (IVR) technology for enhancing existing quitline services (Free & Clear’s Quit for Life® program) to prevent smoking relapse and achieve abstinence. The IVR system screens for six indicators of risk for relapse including smoking lapse, physical withdrawal symptoms, depressive symptoms, perceived stress, decreased self-efficacy for quitting, and decreased motivation to quit. Participants can screen positive on any one or more risks, resulting in a rollover call to a telephone counselor. There are two intervention arms that differ in timing and frequency of IVR screening. In the Technology Enhanced Quitline arm (TEQ-10), 10 automated calls are placed at decreasing frequency for 8 weeks post-quit (twice a week for the first two weeks, then weekly). The High Intensity Technology-Enhanced Quitline arm (TEQ-20) includes 20 IVR calls (daily for the first 2 weeks, then weekly). This preliminary analysis includes IVR data collected on calls from 4/12/2010 to 10/31/2010. 2620 calls were made to 98 participants in the two intervention arms, TEQ-10 (n=44) and TEQ-20 (n=54). The two arms did not differ significantly on demographics or comorbid conditions. Three outcomes were analyzed: completed screening assessments, positive screen for relapse risk, and smoking lapse (i.e., smoking even a puff since the last call). 136 of the 736 (18.5%) completed assessments were positive for relapse risk: 66 for smoking lapse (49%), 42 craving (31%), 32 depressive symptoms (24%), 27 lack of confidence (20%), 8 stress (6%), and 8 lack of motivation (6%). Logistic regression models (adjusted for age and gender), with GEE estimation to account for withinperson correlation, showed that compared to the TEQ-10 study group, participants in the TEQ-20 study group were more likely to complete assessments (OR=1.7; 95% CI=1.2-2.4), less likely to screen positive for relapse risk (OR=.3; 95% CI=.2-.6), and less likely to have smoked (OR=.2; 95% CI=.09-.4). These results indicate that frequent IVR monitoring during the immediate postquit period may have a positive effect on relapse risk

Hepatosplenic candidiasis: Successful treatment with fluconazole

To determine if fluconazole is effective treatment for hepatosplenic candidiasis that has not resolved with amphotericin B and flucytosine treatment. Six patients (ages 3 to 44) with acute leukemia and hepatosplenic candidiasis who did not respond to prior antifungal therapy were treated with fluconazole. All six patients had fever and three had nausea and vomiting, computed tomographic (CT) scan showed lucencies in the liver in six, lucencies in the spleen in five, and lucencies in the kidneys in three. Prior therapy with 1.6 to 4 g of amphotericin B in the five adults and 526 mg of amphotericin B in the child (with the addition of flucytosine in four) failed to improve clinical symptoms or lucencies in the liver, spleen, and kidneys seen on CT scan. Fluconazole was given at a dose of 200 to 400 mg daily (70 to 100 mg in the child) for 2 to 14 months. All patients had resolution of fever and other symptoms in 2 to 8 weeks. Improvement of the lesions noted on CT scan was seen in 4 to 8 weeks in all patients. Total resolution of lesions noted on CT scan occurred by 4 weeks in two patients, but took 4 to 5 months for three patients and 13 months for one patient. Three patients had relapse of their acute leukemia and two died, presumably cured of their candidiasis. Two patients underwent successful bone marrow transplantation without relapse of their candidiasis. Fluconazole appears to be useful in the treatment of hepatosplenic candidiasis that has not resolved with amphotericin B and flucytosine therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29188/1/0000241.pd

The Dutchman Vol. 6, No. 1

● Editorial ● Somerset County Decorated Barns ● Butter Molds ● Restaurants, too, Go Dutch ● The Hostetter Fractur Collection ● Bindnagle\u27s Church ● The Harry S. High Folk Art Collection ● Lebanon Valley Date Stones ● Of Bells and Bell Towers ● John Durang, the First Native American Dancer ● Stoffel Rilbps\u27 Epistle ● The First Singing of Our National Anthem ● Pennsylvania Dutch Pioneershttps://digitalcommons.ursinus.edu/dutchmanmag/1000/thumbnail.jp

Criteria for and Appropriateness of Renal Transplantation in Elderly Patients With End-Stage Renal Disease : A Literature Review and Position Statement on Behalf of the European Renal Association-European Dialysis and Transplant Association Descartes Working Group and European Renal Best Practice

During the last 20 years, waiting lists for renal transplantation (RT) have grown significantly older. However, elderly patients (ie ≥65 years of age) are still more rarely referred or accepted to waiting lists and, if enlisted, have less chances of actually receiving a kidney allograft, than younger counterparts. In this review, we looked at evidence for the benefits and risks of RT in the elderly trying to answer the following questions: Should RT be advocated for elderly patients? What should be the criteria to accept elderly patients on the waiting list for RT? What strategies might be used to increase the rate of RT in waitlisted elderly candidates? For selected elderly patients, RT was shown to be superior to dialysis in terms of patient survival. Virtually all guidelines recommend that patients should not be deemed ineligible for RT based on age alone, although a short life expectancy generally might preclude RT. Concerning the assessment of comorbidities in the elderly, special attention should be paid to cardiac evaluation and screening for malignancy. Comorbidity scores and frailty assessment scales might help the decision making on eligibility. Psychosocial issues should also be evaluated. To overcome the scarcity of organ donors, elderly RT candidates should be encouraged to consider expanded criteria donors and living donors, as alternatives to deceased standard criteria donors. It has been demonstrated that expanded criteria donor RT in patients 60 years or older is associated with higher survival rates than remaining on dialysis, whereas living donor RT is superior to all other options.Peer reviewe

Detecting Higgs Boson Decay to Neutralinos at Hadron Supercolliders

We examine prospects for detecting the neutral Higgs bosons of minimal supersymmetric models (MSSM) when their decays into neutralino pairs are kinematically allowed. The best signature appears to be H_h,H_p\to\tz_2\tz_2\to 4\ell +\eslt. We argue that Standard Model contributions to this signature are negligible, and examine regions of MSSM parameter space where the four lepton mode should be observable at the Large Hadron Collider. The same signal can also come from continuum neutralino pair production. We propose a set of cuts to illustrate that the neutralino decay mode of the Higgs bosons provides a viable signal over a substantial range of model parameters, and show that it may be separable from continuum neutralino production if sufficient integrated luminosity can be accumulated.Comment: 15 pages (REVTEX), 7 figures available by regular mail, FSU-HEP-940204, UH-511-781-9

Language as an instrument of thought

I show that there are good arguments and evidence to boot that support the language as an instrument of thought hypothesis. The underlying mechanisms of language, comprising of expressions structured hierarchically and recursively, provide a perspective (in the form of a conceptual structure) on the world, for it is only via language that certain perspectives are avail- able to us and to our thought processes. These mechanisms provide us with a uniquely human way of thinking and talking about the world that is different to the sort of thinking we share with other animals. If the primary function of language were communication then one would expect that the underlying mechanisms of language will be structured in a way that favours successful communication. I show that not only is this not the case, but that the underlying mechanisms of language are in fact structured in a way to maximise computational efficiency, even if it means causing communicative problems. Moreover, I discuss evidence from comparative, neuropatho- logical, developmental, and neuroscientific evidence that supports the claim that language is an instrument of thought